Provider Demographics
NPI:1881750602
Name:THOMAS A. RAINBOLT, DDS,P.A.
Entity type:Organization
Organization Name:THOMAS A. RAINBOLT, DDS,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:A
Authorized Official - Last Name:GERLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-841-3311
Mailing Address - Street 1:1425 WAKARUSA DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3832
Mailing Address - Country:US
Mailing Address - Phone:785-841-3311
Mailing Address - Fax:785-843-0421
Practice Address - Street 1:1425 WAKARUSA DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3832
Practice Address - Country:US
Practice Address - Phone:785-841-3311
Practice Address - Fax:785-843-0421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS67571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty